Scottish Screening Committee minutes: 13 May 2021

Attendees and apologies

Attendees

Members:

• Jann Gardner, Chief Executive, Golden Jubilee Hospital (Chair)
• Michael Kellet, Director of Population Health, Scottish Government
• Jane Burns, Medical Director, NHS Lanarkshire
• Lisa Cohen, Cancer Research UK
• Susan Siegel, Public Partner
• Bob Steele, UK National Screening Committee Representative
• Fraser Tweedie, Public Partner
• Gareth Brown, Scottish Director of Screening, NHS National Services Scotland
• Scott Urquhar, Director Of Finance, NHS Forth Valley 
• Safia Qureshi, Director Of Evidence, Healthcare Improvement Scotland 
• Graham Foster, Director of Public Health, NHS Forth Valley 
• Colin Briggs, Director of Planning, NHS Lothian

In attendance:

• Tasmin Sommerfield. National Clinical Advisor for Screening, NHS NSS
• Joanna Swanson, Deputy Director, Health Protection Division, Scottish Government
• Laura McGlynn, Committee Secretariat, Health Protection Division, Scottish Government 
• Sheila Devlin, Committee Secretariat, Health Protection Division, Scottish Government
• Agnes Munyoro, Committee Secretariat, Health Protection Division, Scottish Government
• Susan Thompson, Committee Secretariat, Health Protection Division, Scottish Government
• Stacey Berwick, Committee Secretariat, Health Protection Division, Scottish Government

Items and actions

Welcome and apologies

Jann Gardner (JG) welcomed attendees and introduced new Cancer Research Representative, Lisa Cohen (LC). 

JG updated the committee that Lorna Ramsey (LR) would no longer be a committee member, and that Gareth Brown (GB) will represent the National Screening Oversight (NSO) going forward. 

Minutes from the previous meeting were approved

Actions from previous meeting 

GB gave an update on an action to carry out a commission exercise about lessons learned from the Covid response period. While a small number of responses had been received programme Boards and staff had been limited in their ability to make contributions due to pressures of business and other priorities.  The action will remain open and GB and his team will look into conducting a workshop to gather information at a later stage and will report back to the SSC.

Scottish screening programmes recovery update 

GB provided an update on recovery for the adult screening programmes that had been temporarily paused last year – this did not include the Pregnancy and Newborn  Programme as it was not part of the pause. The data used to inform screening programmes recovery analysis is up to end of March. 

Overall uptake does not appear to have been affected, but programmes are operating at reduced capacity and are moving towards normal; progress, however, varies across the country. All programmes are either at phase 3a or 3b of the screening recovery plan.

It was asked whether there will be further information shared about the break down on data of demographics of uptake, e.g. regarding deprivation and age. Tasmin Sommerfield (TS) confirmed it was being looked at, and this will be shared once available.

Diabetic Eye Screening (DES)

The DES programme has been experiencing a variation across the country in terms of recovery progress and the main challenge faced by the programme is capacity and availability of screening venues. 

The programme is prioritising high risk individuals and this cohort is being screened as normal. 

In order to address capacity and localised challenges, there will be ongoing work on data, which will support the programme to gain an understanding of demand pressures across different geographical areas. 

The DES programme proposed writing to the Directors of Public Health and NHS Chief Executives to make them aware of the capacity challenges experienced by the programme and to coordinate local leadership for health boards experiencing the largest challenges.

The SSC discussed learning from the COVID vaccination model, and NSO is working with the Centre for Sustainable Recovery to consider possible approaches to tackling capacity challenges over and above local leadership.  

The SSC agreed with the NSO proposed approach towards addressing challenges.

It was commented that it would be particularly helpful to understand where barriers are, and that local leadership can be supported by emphasising the importance of screening but also encouraging flexibility. 

Abdominal Aortic Aneurysm (AAA) screening 

The AAA programme is moving towards pre-Covid levels and this is largely because there is less accumulated demand. 

The AAA programme needs to exceed 100% of 2019 capacity to catch up with demand after the screening pause, and this is currently happening. 

There are some downstream challenges to manage services; this is being monitored and addressed. 

More action is required to support local leadership with capacity solutions; however there is improvement of overall capacity across the programmes. 

Bowel screening  

More screening kits are currently being issued, and there is a higher uptake in comparison to 2019 data. 

Colonoscopy capacity is looking more positive and there are ongoing discussions amongst Clinical leadership to find different ways of organising colonoscopy capacity.

In response to evidence collated by Bowel Cancer UK, which indicates that the public prefer an update on potential delays at the start of the process, the bowel screening programme has changed the letter issued following a positive result to advise participants may have longer waiting times for follow up appointments due to COVID-19. Work is in progress to facilitate an IT change to update the letters that are sent out with screening kits to similarly advise potential delays. 

 The SSC discussed the gathering and sharing of bowel screening data; waiting times; intervals between screening appointments; and the challenges and potential strategies to increasing capacity.

Greater clarity was sought on the data, and this will be provided in due course to SSC members.

Cervical screening 

The cervical screening programme has screened the majority of people whose appointments were affected by the pause. 

A larger number of non-routine prompts were sent in July and August to help with the catch up. 

A large number of opportunistic screenings have been occurring since the restart of the screening programme after the pause. 

There are delays in colposcopy in some NHS Boards and the Cervical Screening Programme team are working with boards to understand the challenges.

Breast screening 

The breast screening programme is recovering steadily, with uptake being higher than it has been in recent years.

Additional mobile screening units are in operation. 

Work is underway to bring slippage (when there is a greater period of time between offered appointments than the target) within target.

A review of breast screening has been completed and the report is being considered by NSD. The SSC will be updated later in the year. 

Self-referrals for women over 71 remain paused but this is reviewed quarterly. 

National Screening Oversight work plan and annual report update 

GB presented the NSO work plan and annual report.

NSO will publish a work plan and a report annually, giving an update on the work of the NSO and advising of their plans for the following year.

GB highlighted they are seeking to inform people of the NSO and its purpose; to clearly set out the value of screening oversight; and to invest more in modernising systems. 

The SSC supported the work plan and annual report.

UK National Screening Committee (UK NSC) update

Bob Steele provided an update on UK NSC. 

The UK NSC currently sits within Public Health England; however, following the dissolution of Public Health England, the NSC will sit within the Department for Health. 

AOB 

No other points were raised.